Provider Demographics
NPI:1891726691
Name:PR EYECARE CONSULTING GROUP OD PA
Entity Type:Organization
Organization Name:PR EYECARE CONSULTING GROUP OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROGASKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-472-8700
Mailing Address - Street 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2441
Mailing Address - Fax:502-996-8282
Practice Address - Street 1:1040 RANDOLPH STR
Practice Address - Street 2:STE 14-15
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360
Practice Address - Country:US
Practice Address - Phone:336-472-8700
Practice Address - Fax:336-472-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011UPMedicaid
NC4510760001Medicare NSC
NC89011UPMedicaid